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488183
' ~ ~ri~i=DECLARATION OF DOMICILE
To the Clerk of the Circuit Court [County Comptroller] ST. L UGtE County, Florida.
This is my declaration of domici~.e in the State of F ~~r~ r~ that I as filing
this day in accordance and in conformity with Section ~~~.Z ,T~ari~a
$'tatutes.
FOR~OMICILURIES OF THE STATE OF FLORIDA:
I hereby declare that I reside in and maintain a place of abode at 31~ 50. 1 r-,c~ '~IU. nr . f
-Ts ree an n r~
F~1. i ,~r.~,L in ST. LUG i E County, Florida, which place of abode I
tc1LY +
recognize and intend to maintain as my permanent home and, if I maintain another place•or
places of abode in some other state or states, I hereby declare that my above-described
residence and abode in the State of Florida constitutes my predominant and principal haoe,
_ ..and I intend to co~~nue it permanently as such. I am, at the time of akin ihi declara- .
tion, a bona fide resident of the State of Florida residing at X13 S ~1V• Y . +
(street an n er
. ~ ~ ~ 1•C~ in S~ ~ l A ~t .P County, Florida. I formerly resided at
5 c tyj _ ~
c ty ~ ox--rn--P County, , and the
state
place or places where I maintain another or other place or places of abode are as follows:
(Here list street address, city, county and state of any other place or places of abode.)
R
_ _i•~.~
- . signature
J
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~ ..4.~
Sworn to and subscribed before me this a day of u-.,x. , A. D. 19 ~ i
ROGER PO I TRA S, CLERK C I RCU i T GOURT
ST. LUGIE COUNTY, FLORIDA
Notary Pu is State o F on a at Large.
My Commission expires , Br DEPUTY CLERK
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FOR DOMICILIARIES OF STATES OTHER T~iAN THE STATE OF FLORIDiA:
er y ec are t at my onuc a sin the State of and that I intend
to permanently continue and maintain my domicile in suc state. At t e time of making this
declaration I am a bona fide resident of the State of My place of
abode within the State of Florida, if any, is as follows: ere ist street address, city,
and county of place of abode in Florida.)
(Person making declaration may also include such other and further facts with reference to
any acts done or performed by~such person which such person desires or intends not to be
construed as evidencing any intention to establish his domicile within the State of Florida.) ,
. 488183
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signature
sworn to and Rubscribed before me this day of A. D. 19
_ Notary is State o For a at Large.
My Commission expires
3